Can Hawai‘i Cannabis Help End the Opioid Epidemic?

Now that medical marijuana is legal, a homegrown substitute beckons.

By Don Wallace

Published: 2017.12.11 11:07 AM

photos: thinkstock

Starting in 2003, an alarming statistic showed up in annual state health records. Deaths by overdoses were rising, from 79 in 2002 to 125 in 2005. By 2008, they surpassed automobile crashes as the leading cause of fatal injuries in Hawai‘i, hitting 165 in 2015. There was something else that was new: The overdoses weren’t from heroin, but prescription opioids. Although ranked 43rd in the nation for fatal overdoses, like the rest of the U.S., Hawai‘i had woken up in the middle of an opioid abuse epidemic that would kill 59,000 Americans in 2016.

The surge in overdoses nationwide paralleled a rise in medical marijuana legalization (see our October story, “Power Plant,” at bit.ly/hncannabis), driven in part by the hope that cannabis can step in and replace opioids as a pain medication. New methods of applying cannabis using creams, pills, oils and tinctures allow for a targeted approach; the elderly and veteran populations are strong supporters. “Nobody has ever died of a marijuana overdose,” says Brian Goldstein, CEO of Noa Botanicals, an O‘ahu provider. “Ever.”

There’s a particular urgency in the veteran community, where nationwide more than 20 people a day commit suicide, according to the Department of Veteran Affairs. “That’s with only half of America reporting,” says Michelle Tippens, founder and executive director of Hawai‘i Veterans Cannabis Alliance. “They think the numbers are closer to 72 a day.”

Many veterans who have post-traumatic stress disorder, marked by anxiety, sleeplessness and nightmares, are given opioids. “These drugs are a weapon. In a moment of darkness, that’s how veterans overdose,” says Dr. Sue Sisley. Medical director of Noa Botanicals and consultant for 11 other dispensaries, including one in Sweden, Sisley is conducting an FDA Phase II study of “the safety and efficacy of cannabis for treatment-resistant PTSD in veterans” at the University of Arizona.

“Veterans have a 33 percent higher rate of overdoses,” she says. For them, “cannabis is a life-changing medicine. It’s a transformative experience for them.”

Dr. William Haning has sympathy for the veterans, because he’s one of them, having served in Iraq. But, “we should be suspicious. There’s a lot of conflicting data on this.” Professor at the John A. Burns School of Medicine at the University of Hawai‘i, as well as director of M.D. programs and addiction psychiatry and medicine residency training, Haning acted as principal investigator for the Pacific Addiction Research Center. “As a substitute for opioids or methamphetamine, you’ll search in vain,” he says, for studies showing any correlation.

Sisley blames the government for the lack of hard science, by classifying marijuana as a Schedule I Controlled Substance. “It took me seven years to get federal approval for my study,” and 22 months to procure cannabis for testing from the government’s sole grow site in Mississippi. A self-described “very conservative Republican,” she adds, “We faced a really oppressive atmosphere.”

Rumors still circulate that U.S. Attorney General Jeff Sessions will take aim at legal cannabis states. But for now, Hawai‘i veterans with a 329 medical marijuana card can self-medicate—and steer clear of opioids.

The most commonly abused opioids

Oxycodone (such as OxyContin, Percocet)

Hydrocodone (such as Vicodin)

Hydromorphone (such as Dilaudid)

Fentanyl (50 to 100 times more powerful than morphine, often illegally imported and mixed with other drugs without consumer’s knowledge)